International Personality Disorder Examination (IPDE)
Overview and Current Status
The IPDE is a semistructured clinical interview designed to assess DSM-IV and ICD-10 personality disorders, but clinicians should recognize that this instrument is now largely outdated given ICD-11's fundamental restructuring of personality disorder diagnosis away from discrete categorical types. 1
Historical Context and Administration
The IPDE was developed as part of the WHO/ADAMHA international program and demonstrated acceptable reliability across 14 centers in 11 countries 2. The instrument:
- Administration format: Semistructured clinical interview conducted by trained psychiatrists or clinical psychologists
- Compatibility: Designed for both ICD-10 and DSM-III-R/DSM-IV classification systems
- Reliability metrics: Demonstrated interrater reliability and temporal stability (6-month retest) comparable to instruments used for psychotic, mood, and anxiety disorders 2
Key Administration Points
The IPDE requires:
- Trained clinicians (psychiatrists or clinical psychologists) to administer effectively 2
- Approximately 90-120 minutes for full administration in clinical settings
- Assessment of enduring patterns of behavior, not acute state symptoms
- Evaluation across multiple domains of personality functioning
Screening Questionnaire (IPDE-SQ)
A self-report screening version exists with important caveats:
For adolescents: The 3-item cutoff produces excessive false positives. Use 5 positive items for DSM-IV borderline PD and 3 items for ICD-10 impulsive/borderline PD for primary screening 3. For secondary screening in clinical populations, use one item above these thresholds 3.
For adults: The 59-item IPDEQ version can be administered by trained non-clinical interviewers in computerized format, with three scoring schemes available (categorical, criterion-based categorical, and dimensional) 4.
Interpretation Challenges
Critical Limitations
The categorical approach underlying the IPDE is not empirically supported 1. Major problems include:
- Large proportions of patients meet criteria for multiple personality disorders simultaneously
- Poor discriminant validity between discrete categories
- Comparison studies show 60% of variance in personality disorder diagnoses represents measurement error rather than true patient characteristics 5
Reliability Varies by Disorder
When comparing IPDE with diagnostic checklists, kappa values ranged from:
- -0.07 to 0.71 for DSM-III-R diagnoses
- 0.38 to 0.68 for ICD-10 diagnoses 5
This wide variability indicates some personality disorder categories are more reliably assessed than others.
Clinical Implications for Current Practice
ICD-11 Has Replaced Categorical Diagnosis
ICD-11 eliminated discrete personality disorder categories entirely 1. The new system uses:
Single personality disorder diagnosis based on:
- Problems in self-functioning (identity, self-worth, self-direction)
- Interpersonal dysfunction (empathy, intimacy, conflict management)
Severity grading: Mild, moderate, or severe
Optional trait specifiers: Negative affectivity, detachment, dissociality, disinhibition, anankastia, and borderline pattern
Practical Recommendation
If you are still using the IPDE for DSM-IV/ICD-10 assessment, recognize you are using an outdated framework. For contemporary practice:
- Use IPDE results to inform the severity rating (mild/moderate/severe) in ICD-11
- Map IPDE categorical findings to trait domain specifiers in the new system
- Focus on dimensional scores from the IPDE rather than categorical diagnoses, as these better reflect current understanding of personality pathology 4
- Consider the IPDE primarily as a structured way to gather comprehensive personality information rather than as a definitive diagnostic tool
Common Pitfalls to Avoid
- Do not diagnose multiple discrete personality disorders - this reflects the flawed categorical system, not true comorbidity
- Do not use screening questionnaires alone for diagnosis - they require follow-up with full interview 3, 4
- Do not apply adult cutoffs to adolescents - different thresholds are needed 3
- Do not ignore the 60% measurement error - use clinical judgment alongside structured assessment 5